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Review
. 2016 May;17(3):264-70.
doi: 10.5811/westjem.2016.3.29294. Epub 2016 May 5.

Anticoagulation Reversal and Treatment Strategies in Major Bleeding: Update 2016

Steve Christos  1 , Robin Naples  2
Affiliations
Review

Anticoagulation Reversal and Treatment Strategies in Major Bleeding: Update 2016

Steve Christos et al. West J Emerg Med. 2016 May.

Erratum in

No abstract available

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Figures

Figure 1
Figure 1
Coagulation cascade and site of action of anticoagulants.
Figure 2
Figure 2
Reversal strategies for conventional anticoagulants in patients with significant bleeding. PCC, prothrombin complex concentrates; INR, international normalized ratio; IVPB, intravenous piggyback; FFP, fresh frozen plasma ^4F-PCC contains heparin and is contraindicated in patients with a history of heparin induced thrombocytopenia. *4F-PCC has factor concentrations 25 × greater than FFP. Reversal of INR with 4F-PCC is within 30–60 minutes versus 6–24 hours in FFP. Risk of volume overload and transfusion-related acute lung injury (TRALI) with FFP. Thrombotic event rate 8.7% for 4F-PCC vs. 5.5% with FFP. #Off-label use.
Figure 3
Figure 3
Reversal of direct oral anticoagulants (DOACs) in patients with significant bleeding. FFP, fresh frozen plasma; rFVIIa, Recombinant human Factor VIIa; PCC, prothrombin complex concentrates; FEIBA, Factor Eight Inhibitor Bypassing Activity; NG, nasogastric #Off label use. ^4F-PCC contains heparin and is contraindicated in patients with a history of heparin induced thrombocytopenia. ¥Not currently available on market. FDA trials ongoing. Dosing based on published Phase 3 trial.
Figure 4
Figure 4
Fab fragments (aDabi-Fab) reversal effects on dabigatran.
Figure 5
Figure 5
Andexanet alfa mechanism of action video.
See this image and copyright information in PMC

References

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MeSH terms